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UNITED STATE PATENT FFTCE.`

DAVID B. W. HARD, OF BETHLEHEM, OONNCTICUT.

TRUSS.

Specification of Letters Patent 1\To. 4,052, dated May 16, 1845.

To aZZ 'whom it may concern Be it known that I, DAVID B. W. HARD, ofBethlehem, county of Litehfield, `State of Connecticut, have invented anew and useful mprovement on a Machine Known by the Name of Truss, aSurgical Instrument Used in Hernia; and I do hereby deelare that thefollowing is a full, clear, and exact description of the constructionand operation of the same, reference being had to the annexed drawings,making a part of this specification, in which- Figure 1 gives a plainand clear view of the parts I claim to have invented and Fig. 2 the kindof truss to which I have adapted my improved pad, Fig. 1.

Plate A, Fig. 1, is a circular metallic plate, which by being struclr ina die, is brought into a concave-convex form, being convex on one sideand concave on the other, and in this form is about two inches in itsgreatest diameter, and the greatest perpendicular depth of its concavityis rather more than half an inch.` At one third of the distance from theedge of the plate to its center, it is perforated with small holesextending around it in a circular form for the purpose of passingthrough stitches to attach to it the cover hereafter to be described.These perforations are seen at f. At (Z, (Z, the plate is perforated toreceive the endof the spiral springs o, o. These perforations are madeat of an inch from the edge of the plate A, and placed at equaldistances with respect to each other so that where three springs areused they would be made in the angles of an equilateral triangle drawnwithin the concavity of the plate A.

At B, Fig. 1, is represented a circular metallic plate, about an inchand three fourths in diameter. The whole circumference of its edge (bybeing struck in a die) is turned downward to the depth of about of aninch, as is seen at the shaded margin of the figureiat h, h, forming aflat circular plate with a narrow edge turned downward around its wholecircumference. Near the edge of the plate, extending all the way aroundit, the plate is perforatedwith small holes as is seen at f. g, is afemale screw in the center of the plate at e, e, e, is represented wherethe Springs c, 0,0, are made fast to the plate. The plates A and B aremade of sheet brass, the thickness of which is equal to one thirtysecond part of an inch, but any other thickness may be used that greaterstrength are needed wire may be used one, one and a half, or two numberslarger, or even larger still, which, however, I think will be seldomneeded. These springs are made an inch and a half in length from oneextremity of the coil to the other. The coil of the spring is smaller,in

the middle and larger at each eXtremity, as

is shown in the drawing, so that each successive coil (when the springis pressed to-` get-her) may pass one without the other. This form ofspring is adapted so as. to o'btain a more extensive action by itsadmitting of being compressed in a narrow space. These springs arejoined to the plate A, by bending the end of the wire at a right angleon itself and passing it through the perforations (Z, (Lwhere it isfastened by riveting.`

The other extremity of the Springs are joined to the plate B, at e, e,but instead of one, two perforations are made through the plate B,separated one fourth of an inch from each other, so the end of the wirewhich terminates the coil being bent at a right angle is passed outwardthrough one of the holes and immediately bent and passed inward throughthe other and beat down upon the inside of the plate B. This arrangementmay be clearly understood by the inspection of e, e, e. The forkeddotted lines show the two perforations of an inch apart and the straightdotted line indicates the wire passing between them which is beat downon the inside of the plate B. This mode of connection between the plateand Springs has suflicient strength and is con- Venient, but they may befastened together by soldering or any othercontrivance. The foregoingdescription relating to size and admeasurement of the parts thereinf.described very nearly relates to the dimensions of the modelaccompanying this specification, but in the practical application of theinstrument different sizes are needed to suit individual cases.Consequently I construct various sizes, some larger and some smallerthan the admeasurements of the parts herein described. Under somecircumstances to suit particular cases of inguinal hernia I or othersoft leather.

. eighths in diameter.

vary the form of the plates from a circular to an elliptical or ovalform.

To the conveX surface of the plate A is applied one or two thicknessesof fiannel blanketing or other cloth or any other suitable substancethat will serve as padding. rThis is fastened to the plate by stitchespassed through the holes f. This is cut in a circular shape and eXtendsone fourth of an inch beyond the edge of' the plate. To form the coverof the pad I use any suitable material, as linen or other cloth,buckskin I cut two circular pieces of unequal size, the largest threeinches and three eighths of an inch in diameter and the smallest 2inches and two Both of these pieces aresewed to the plates A and B bystitches passed through the holes f, f, the largest to the plate A andthe smallest to the plate B, and these two circular pieces sewedtogether at their edges shaped to approXimate the edges .of the twoplates A and B as to be separated by a space not exceeding or of aninch.

My pad Fig. 1 I attach to a truss in common use shown at Fig. 2, inwhich A is a Strap of iron or steel passing from the inguinal region infront around the back and terminating on the hip opposite to the one itpasses around. This is inclosed in a belt padded or wadded on its innerside and is lengthened so as to pass entirely around the body andterminates in the lighter strap Z) which is perforated with buttonholes, to button lon to the knob c. Gr is a plate of brass about 2-3inches in length by 111- inches width. Moving at D upon the pivot I is ahinge joint. E is a ratch with a spring catch fitted to it whichgraduates the movements of G. F is the pad Fig. 1, attached to G by themale screw H. The conveX surface of the pad is applied on the integumentimmediately eXterior to the rupture or opening through which the viscerydescends to form the hernia, the requisite degree of pressure isobtained by pressing (with the hand) the pad upon the part to which itis applied in which precise situation it is retained by the ratchet(before described) with which it operates in connection. The pad is soconstructed that when applied in this manner that the arrangement of aplurality of spiral springs of small dimensions within itself admits ofevery variety of movement and motion of the body in all the variedoccupations. among individual persons without displacng the convexsurface of the pad, but all the shocks and impulses given to the pad, bysudden or energetic movements of the individual to whom it is applied,is received by and compensated for, by the action of the Springs, whilethey all the while exerting a steady pressure upon the convex platemaintain it in its required position after it has been placed there bythe wearer. So that by being steadily maintained in its correct positionwithout being liable to slide or being otherwise moved about on it; orrudely to compress the iutegument-( all of which takes place where ahard pad is used) it with great certainty prevents the descent of thehernia7 is free from the liability to chafe, irritate or eX- coriate thesurface upon which pressure is made. And by the certainty of its actionin preventing a descent of the intestine, increases therein anindefinite degree the prospect of radical and permanent cure.

I will now describe more particularly the motions and action of thespiral springs described in the foregoing instrument. '*Vhen a hard padis used where pressure is obtained by the ratchet truss described atFig. 2 it is necessarily dead pressure "Where my pad Fig. l is used withtruss Fig. 2, the pressure by the interposition of the spiral Springs iselastic pressure. Equally important with the elastic pressure is adiversified variety of motions made and allowed by the spiral Springs.lst a limited circular motion of the plate B backward and forward as ifon an aXis passed perpendicularly through its center. Qnd a lateralmotion, permitting the edge of the plate B to pass without and beyondthe edge of the plat-e A. 3rd a mo-tion of the Springs which admits theedges of the two plates on one side to be brought one within the otherforming a kind of angular junction while the edges opposite areproportionately separated and in this oblique position of the plates Aand B this angular junction may be progressiv-ely formed around theentire circuit of their edges. All the above described movements of thesprings take place in a greater or less degree when the instrument isapplied and in use, giving ease, comfort, and

security to the individual who wears the instrument. By fastening thebase of the Springs, near the margin of the concavoconvex plate, as isseen at (Z, d, Fig. 1 aids essentially (as I have ascertained from eX-periment) in preserving this plate steadily in its required positionwhile the Springs and plate B are in action and motion, the force of theSprings being more sensibly felt around the cir'cumference of the plateand the leverage power being greater than if inserted at any pointnearer the center.V By constructing plate B Fig. 1 smaller than plate Ait will pass within and somewhat below the circular concave opening` ofthe edge of plate A gaining by this arrangement a more extended actionof the Springs and obtaining a better form to the pad. The conveX plateA has connected with its peculiar shape and size a two fold object oneof which is a conveX surface which forms a suitable foundation, uponwhich to arrange the covering, cushioning and stufing thereof in mannerherein before and hereinafter described. p And the other object is thatthe side plate A being larger in its diameter than the plate B and itsedges projecting beyond the edges of plate B while at the same time theconcavity of the said plate A having considerable depth and consequentlyraising its edge higher, the said edge is made to approach (when thecover before described is applied) within about onefourth of an inch, tothe edge of plate B which is turned toward it. this arrangement is itcloses the space between the edges of A, and B, so nearly as eifectuallyto prevent the cover from falling in between the edges of the saidplates. By attaching` the cover and padding to the conveX surface ofplate A by passing stitches through the holes f, as before described,all that part of the cover and padding included within the said circleof stitches being firmly pressed in contact with the plate is hard.VVhen pressure is made on the two plates A and B So as to bring themnearer together the cover and padding exterior to the circle of holesand stitching f separates and falls away from the plate A and presents asoft yielding surface like a cushion, everywhere surrounding the hardcentral surface before described. I increase the fullness and softnessof the said cushioned part if I deem it proper by adding theretostufiing of wool or other suitable material attached to the paddingalready described.

The object and purpose of the combined hard and soft surface connectedwith plate A as before described is the hard central portion I apply onthe integument directly exterior to the hernial opening, by its hardnessit excites adhesive infiammation in the ruptured part and causes it toheal-but when a hard pad is used in the treatment of hernia-which has nosoft eXterior margin the hard pressure will terminate abruptly aroundthe edge of the padwand at that place leave the skin suddenly withoutsupport the consequence is that by a law of the animal economy theintegument puffs up with swelling around the edges of the pad 'I`heeffect of where the hard pressure terminates -and this swelling becomessore and ulcerates. This painful result I prevent from taking place byapplying a soft outer margin to a hard pad so constructed that it can beprevented from becoming hard by use and so arranged that the hardpressure is relieved by a gradually diminished degree of hardness andpressure extending out to the exterior lnargin of the padby thusexerting a gentle pressure on the skin exterior to the hard pressure-Mitgives such support to the integument as prevents it from swellingand bypreventing swelling the surface of the integument is preserved in astate of health and soreness and ulceration prevented. Fig. 3 shows asection of my pad when it is in operation, A the concavo-convex platewith its edge projecting beyond the edge of the plate marked B, whichhas its edge turned toward its fellow plate A. G, G, G, the cover withthe blanket pading z' z' and the wool stufiing H, I-I, loosened andseparated from plate A, by pressing the two plates A and B nearertogether. f f circle of stitching made through the holes g-between f fshowing the cover in contact with plate A. C the springs-Ja the screw.

I do not claim the manner of eifecting the elasticity of my pad by meansof spiral Springs as that has before been done; butI That I do claim asmy invention is- 1. Combining with a pad so rendered elastic, thecushion and stufiing thereof, in such manner that the central portion ofthe pad shall present a hard surface, while the portion exterior to saidcenter shall be of a soft yielding nature and at the same time eXert agentle pressure.

2. And I further claim in combination with the above pad and cushion,making the concavo-convex plate A project beyond the edges of the plateB, so as to efiectually prevent the cover of the pad from coming betweenthe two plates in the form and manner set forth.

DAVID B. W. HARD. Witnesses:

T. C. DoNN, J osEPH HARBAUGH.

